Balancing different expectations in ethically difficult situations while providing community home health care services: a focused ethnographic approach

Abstract

BackgroundThe general opinion in society is that everyone has the right to live in their own home as long as possible. Provision of community home health care services is therefore increasingly common. Healthcare personnel encounter ethically difficult situations when providing care, but few studies describe such situations in the context of community home health care services.MethodThis study has a qualitative descriptive design, using focused ethnography. Data from 21 days of fieldwork (in total 123 h) consisting of non-participant observations (n = 122), memos and informal interviews with registered nurses (n = 8), and nurse assistants (n = 4). The transcribed texts were analyzed with interpretive content analysis.ResultsThe inductive analyses revealed two categories: 1) difficulties in balancing different requirements, expectations and needs, and 2) use of coping strategies. The results demonstrate that there are different values and expectations that influence each other in a complex manner. The personnel dealt with these situations by generating strategies of coaxing the patients and finding a space to deliberate and share difficult emotions with their colleagues.ConclusionsThis study reveals that complex ethically difficult situations emerged in the context of community home health care services, and healthcare personnel were forced to find a balance regarding the different demands, expectations, values and needs that influence the care provided.

Perceptions of Professional Responsibility When Caring for Older People in Home Care in Sweden

“…As demonstrated in the present study, limitless responsibility and being constrained by time have proven to be a problem among professional caregivers who find it difficult to handle demands, expectations, and values, both from themselves and others (Rasoal et al, 2018). Rasoal et al (2018) also mentioned the challenges of balancing laws and caring that focuses on the individual when care is perceived as not being congruent with the conditions needed to ensure safety and provide equal care. This highlights how responsibility requires professionals to be competent.…”

“…Consequently, professionals prioritize their routine tasks, forcing the older person to adapt (Jarling et al, 2018). Ethical dilemmas can arise when it becomes difficult for professional caregivers to make decisions (Rasoal et al, 2018).…”

“…Working as a professional caregiver includes meeting older people with complex needs and being exposed to difficult situations and challenging decisions (Furaker, 2012) that include ethical aspects. Caring places high demands on professional caregivers because it includes interpersonal relationships (Meiers & Brauer, 2008), not only with the older person but also with his/her family (Jarling et al, 2019;Rasoal et al, 2018). To better understand how these requirements manifest and how they are handled, the present study aimed to describe perceptions of caring responsibility in the context of older people's homes from the perspective of professional caregivers from caring professions.…”

Autonomy conquers all: a thematic analysis of nurses’ professional judgement encountering resistance to care from home-dwelling persons with dementia

“…Moreover, communication had decreased in recent years due to the removal of oral reports and as a result of meeting restrictions during COVID-19. Previous research has demonstrated a need for support when facing ethically challenging situations of care [ 35 , 38 ]. This has been politically acknowledged.…”

Ethical challenges in home-based care: A systematic literature review

“…Qualitative interviews with 19 healthcare and social care professionals Challenges related to autonomy and self-determination 31. Rasoal et al, 47 Norway, English Qualitative, ethnographic observations and informal interviews with 8 nurses and 4 nurse assistants Challenges related to autonomy and self-determination 32. Ross, 48 Canada, English…”